The Value of Half-Body Technetium-99m-Labeled Red Blood Cells Subcutaneous Radionuclide Venography in Differential Diagnosis of Lower Extremities Edema

Received 10/28/2002; revised 12/10/2002; accepted 12/30/2002. For correspondence or reprints contact: Chien-Chin Hsu, M.D., Department of Nuclear Medicine, Chung-Ho Memorial Hospital, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan. Tel: (886)7-3121101 ext. 7152, Fax: (886)7-3117521, E-mail: [email protected] Radionuclide venography (RNV) is a useful screening technique on patients with clinically suspicious deep vein thrombosis (DVT) of lower extremities. In our hospital, many patients with lower extremities edema received Tc-labeled red blood cells (Tc-RBCs) subcutaneous RNV (SC-RNV) to rule out DVT. In addition to venous flow, Tc-RBCs SC-RNV images also provide other useful information including vascularity, space-occupying lesion and inflammatory hyperemia, etc. In this article, we reported two cases of clinically suspicious DVT but proved to be other disorders according to the image of SC-RNV. First case was a 57-year-old male patient with stroke history. He suffered from right lower extremity edema for about ten days. Blood pool image of Tc-RBCs SC-RNV showed hyperemia in the right swelling thigh with a linear photopenic defect. Surgical intervention and pathological result demonstrated a huge hematoma in the right thigh. Second case was a 66-year-old female patient. She suffered from right lower extremity edema for about 1 week combined with fever and right knee joint pain. Tc-RBCs SC-RNV blood pool image showed deep venous flow and hyperemia over the right knee area. Tc-MDP three-phase bone scan revealed active bone lesion involving the right knee and septic knee was considered. After antibiotic treatment, the symptoms improved. We conclude that Tc-RBCs SC-RNV is a useful and non-invasive procedure which assists clinicians in differential diagnosis of lower extremities edema, not only in detecting DVT.